Through SB 1325, the California Medical Association fought and won the right for a medical staff to have a legal identity. SB 1325 enshrined in law the principles of medical staff self-governance. Yet do we have the will to stand up and fight for the principles of SB 1325?

A SLAPP (Strategic Lawsuit Against Public Participation) provides an interesting legal technique to reduce public criticism by any person or entity with whom you disagree. If someone disagrees with you, sue him! In most cases, just the threat of legal action squelches critics.

Specialization offers patients the "best of times," through focused research and advanced technology. However, specialization also allows for the "worst of times." Too often we label ourselves as our specialty. Perhaps we can bring back more caring and compassion in our daily work by thinking of ourselves as physicians first.

In P4P programs, the measurement of biochemical markers glows as an indicator of quality healthcare. Physician groups count on rewards for excelling at measuring these biochemical markers. It seems the act of measuring quality is all the rage, but does it apply the same way in healthcare as it does in other industries, such as manufacturing?

My experience of evolving from a small family practice into a medium-sized multispecialty medical group triggered thoughts on the dilemma that forced this transition. Having lived through the revolution from patient responsibility to employer responsibility for payment of medical care, I offer these thoughts. I present this through the limited view of outpatient practicing physicians.

In an editorial by the Los Angeles Times, the editors concluded that the recent difficulties at the UC Irvine Medical Center liver transplant program mandated the removal of Thomas Cesario, MD, dean of the medical school. I surmise that their (faulty) reasoning emanated from their belief that the dean was responsible for actions taken at UCI Medical Center.

Multiple issues compete for headlines: immigration reform, nursing PhD programs, physician extenders, and California's high school exit exam. How do these topics impact our concerns? They indicate a physician shortage.

Medical staff leaders rejoice! California's Fourth Appellate District Court of Appeals decided that Integrated Healthcare Holdings Inc. did SLAPP Michael Fitzgibbons, MD. Many of us monitoring medical staff issues view this as upholding our right to speak up for our patients and the quality of care in hospitals.

After 18 months of hibernation, the California Medical Association House of Delegates awakes next month in Sacramento to debate issues facing California physicians. Because we confront daily challenges to providing patient care, we need a voice to express our concerns about the financing and regulation of our profession. The HOD beckons, "Come and be heard!" And usually more than 800 doctors answer the call.

In August, I met my medical revivalists. They did not inspire like Billy Graham, rant like Elmer Gantry or seek financial contributions like many TV preachers. They conducted a course for the American Medical Directors Association, or AMDA. Pronounced "am duh," the acronym belies their sense of dedication and commitment.

Fusion is a word commonly associated with restaurants and food. Have you eaten French-Chinese fare? This morning, I reveled over a strawberry burger. But how does the concept of fusion apply to medicine? Is there an opportunity for us to explore American-Thai medical care? Can you imagine an Orange County-Jaipur cholecystectomy?

Conflicts in paying for medical services relate to the terms used. Practitioners and healthcare facilities prefer to charge "usual and customary" fees for their services. Insurers and private-pay customers want to pay "fair and reasonable" prices for service. And in the for-profit environment, prices are "what the market will bear." After 30 years in healthcare, I think of these payment conflicts as locomotives of varying size and power. Each train carries a different constituency.

The day before the Governator delivered his State of the State address, he delivered a shock to doctors. He announced a wrongheaded plan to "fix" the healthcare system. It appeared that he didn't learn anything from his 2004 battle with other professionals dedicated to society's infrastructure--teachers, police officers and firefighters.

Like many people, I find comfort in stability, consistency and predictability. However, the thrill of new things and different ways to solve problems is exciting to me. Local physicians are definitely in for some exciting changes as the year rolls on.

For the 10th year, the California Medical Association and the CMA Foundation will present the California Health Care Leadership Academy. This year's theme is "Creating the Future of Health Care."

On March 19, Jay Zubrin, MD, past president of the Orange County Medical Association, reinvigorated the association's Organized Medical Staff Committee. Greg Abrams, Esq., from the California Medical Association Legal Department, spoke to 30 medical staff leaders about medical staff self-governance, a timely topic for Orange County. Within the past four years, six hospitals changed ownership resulting in angst among medical staff members.

In April, I attended the California Medical Association Health Care Leadership Academy in Monterey and then went to a planning session with my peers. The information and ideas seemed inconsistent, which is perhaps consistent with the turmoil within the field of medicine.

The current debate on immigration reform has given me a chance to reflect on international medical graduates (IMGs). America's allure of prosperity and political and economic freedom has led many physicians trained overseas to the United States, including me, a Canadian.

The debate surrounding American medical care prattles with many unworkable myths. Join me as I examine four of the myths.

The Medical Board of California announced in July the termination of its Diversion Program, effective June 30, 2008. The decision stunned most of us, and the California Medical Association appropriately responded by condemning the decision.

In the past decade, the measurement of physician actions has increased drastically. Insurers have launched pay-for-performance programs designed to reward physicians for demonstrating measurable value. Specialty boards have instituted requirements to size up physicians' skills with more frequent recertifications. The latest development in physician measurement comes from the Joint Commission.

While at the California Medical Association House of Delegates, members of the Solo and Small Group Practice Forum (SSGPF) invited me to attend a presentation by Howard Lang, MD, dealing with peer review and medical staff issues. The evening evolved into a self-confessional discussion about insurance contracting.

I ended an article in last month's issue of Southern California Physician on an ominous note: seeking a requiem for my chosen specialty of Family Practice. Over the past few months, however, I have started to sense a new reality. It starts from analyzing successes in reducing the risk associated with heart attacks and improvements in aviation safety.

The nationally acclaimed conference Health Politics and Policies in an Election Year gathered thought leaders together to stimulate the audience about the business of healthcare and its political implications for the future. I share with you a few glimpses of the presentations and my interpretation of their messages.

The Joint Commission recently produced its annual standards for hospital accreditation for 2008.